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The following is a summary of “Can the Association of the Biomarkers GFAP and UCH-L1 Predict Intracranial Injury After Mild Traumatic Brain Injury in Adults? A Systematic Review and Meta-Analysis,” published in the April 2025 issue of Annals of Emergency Medicine by Puravet et al. 

Researchers conducted a retrospective study to analyze the predictive value of combined glial fibrillary acidic protein (GFAP) and ubiquitin carboxy-terminal hydrolase L1 (UCH-L1) measurements for intracranial injury following mild traumatic brain injury (mTBI).  

They performed a meta-analysis to evaluate the prognostic role of GFAP and UCH-L1 blood levels in detecting intracerebral lesions after mTBI. The protocol was registered with PROSPERO (CRD42024562587) and included studies involving adults with mTBI who had cranial computed tomography and GFAP and/or UCH-L1 testing. The study quality was assessed by using the Quality Assessment of Diagnostic Accuracy Studies 2 criteria and Medline, Embase, and the Cochrane Central Register of Controlled Trials were searched.   

The results showed that out of 379 screened articles, 16 met the inclusion criteria. The combined use of GFAP and UCH-L1 yielded a pooled sensitivity (Se) of 100% (95% CI 99% to 100%) and specificity (Spe) of 31% (95% CI 26% to 36%). The GFAP alone showed a Se of 94% (95% CI 91% to 97%) and Spe of 40% (95% CI 34% to 46%), while UCH-L1 alone had a Se of 83% (95% CI 69% to 94%) and Spe of 51% (95% CI 40% to 63%). The area under the curve was 88% for GFAP, 67% for UCH-L1, and 97% for the GFAP/UCH-L1 combination.  

Investigators concluded that the combined measurement of GFAP and UCH-L1 demonstrated 100% Se and negative predictive value for excluding intracranial injury after mTBI, suggesting a potential 31% reduction in cranial computed tomography scans, although variations in sampling hindered specific recommendations. 

Source: annemergmed.com/article/S0196-0644(25)00146-5/abstract